When the radiation starts for Dot James, her medical team watches intently as the scans of her small lung tumour blink and shift as the dose aimed at her cancer climbs.
James is in another room, visible through the glass window.
The 82-year-old lies strapped to the bed, her hands high above her head and her chest compressed to minimize the motion of her breathing.
The steady drone of beeps last for about two minutes. In that time, James has received an incredibly high radiation dose that zeros in on her cancer in a way previously not available in Prince George.
In fact, James is the Centre for the North's first patient to have this particular kind of treatment, called stereotactic ablative radiotherapy (SABR). The machine is so precise with its radiation beam - within a few millimetres - that it is safe to deliver high doses to small tumours too difficult to reach through surgery.
"It really is quite possible that in the future this is what you do for early stage lung cancer. You wouldn't even consider surgery because it has way less side effects," said Dr. Rob Olson, a radiation oncologist with BC Cancer Agency Centre for the North.
Most have no side effects, and while it's a fairly new approach in B.C. - in the last five years or so machines have come to Vancouver, Victoria and Kelowna - the practice is more widespread in the United States and Olson expects in a few years he can speak with certainty about how it compares as a treatment option.
"It's almost imitating surgery," said Olson, but "it's totally different than having your rib cage cut open."
This type of radiation kills less good tissue because it's so focused on the affected area, using accurate scans of the tumour. Olson allow for a little margin of error, but still smaller than traditional radiation.
With James, the chance of her cancer coming back is less than five per cent.
"It's that effective and of course there's always the chance it will spread somewhere else... but it's not going to fail because it didn't get enough radiation."
The high doses mean a patient's radiation treatment can be compressed into just four visits over a week and a half. Before, it could mean up to 30 visits over a month and a half. It takes about 10 minutes longer to set up, but treatment takes less than 40 minutes.
It also allows doctors to treat patients who would never be considered for surgery. For now, it's meant for those with early stage lung cancer and those who don't want surgery.
"If you can imagine people who have a lung cancer that's right beside a major blood vessel. You can't give that dose to a heart. Now we can treat these tumours that we couldn't treat before," Olson said.
Or, in James' case, a person might be too fragile to undergo surgery.
"She's on oxygen," said Olson of James.
"She doesn't have any extra reserves. If we cut out one of the lobes of her lung, she probably couldn't live through that."
"It's been growing over the last almost year because she didn't want to go anywhere else to have her treatment so she waited. People are actually not having curative treatment because they don't want to go."
James lives in Vanderhoof and said a trip down to another city for treatment was out of the question.
"It meant that I wouldn't have to go away for any periods of time," said James, who received her fourth and final treatment on Jan. 20.
"My lungs are at very low capacity. It's a godsend really."
She said she's usually quite tired after treatments.
"It doesn't hurt... but I can feel (it) work on certain spot," she said.
Bringing SABR north
Olsen, who also a principal investigator for a B.C.-wide clinical trial with SABR, has been advocating for years to bring the approach to Prince George.
For the last year the centre has been working to make that happen. It repurposed an existing radiation machine, but needed a number of add-ons.
It cost about an additional $30,000, Olson said, to cover the mobilization equipment and a "synthetic diamond detector."
The last essential piece, which is made of carbon, can test how accurate the machine is. It came from a Spirit of the North donor who gave $10,000 to cover the cost.
Judy Neiser said it was important to Don George, whose wife Jean passed away in November 2013, that the money he donate benefit patients in the north.
"The family didn't want any recognition, but they truly believed that it was something that would help," said Neiser, Spirit of the North CEO.
She recalled a watching the machine work with medical physicist Quinn Matthews.
"It's like drawing with a felt marker and drawing with a fine tip pen where you can go with this (device). When they explained it to me they absolutely made sense," she said.
"Cancer does not form in these round little balls that you can zap when you're doing radiation. It wiggles into every little nook and cranny," said Neiser.
Every patient has a custom mold of their body and a planning scan weeks before treatment. Throughout the four sessions, further CT Scans are taken to ensure nothing has moved, and if it has they adjust where they send the radiation.
"We can actually see the tumour itself because we have good enough contrast with this device to see the soft tissue. Then we can move that tumour exactly in the position," said Matthews.
The amount of radiation varies based on the patient's tumour and where the cancer appears in the body.
"If you're going through a bone, in order to get a dose to the lung tumour, you need to give more radiation than if you go through a lung," Olson said. "It's very customized."
Neiser said Spirit of the North was happy to be involved and to have formed a partnership with BC Cancer Agency to set up a local fund.
"I love the partnership that it's created. I think it's afforded people who chose to give to the area of oncology or cancer treatment something local to be a part of," said Nieser, especially bringing specialized equipment to Prince George
"(The machine) really can do so much more because people's cases are very unique and it's always it's nice when you have the ability to have that equipment and don't have to send that family south."
